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Understanding Sustainable Financing Options

Sustainable financing for in-home asthma care may come from multiple sources, both short-term, such as grants, and long-term, sustainable streams, such as health care reimbursement. Bringing multiple streams of funding together to cover the full spectrum of in-home asthma care is often referred to as "braided funding." Healthcare funding, particularly Medicaid reimbursement, and housing funding streams are often braided together to support multi-disciplinary in-home care—where, for example, Medicaid pays for disease education while housing funds pay for structural remediation. New funding streams, like social impact financing, are also being used as supplemental funding to cover costs outside of healthcare and housing's reach.

Braided Funding

Braided funding refers to the use of multiple funding streams to pay for a variety of in-home asthma care services—ranging from education alone to education, assessment and structural remediation—with careful accounting of how each dollar from each stream is spent. The concept of "braiding" conveys that though funding streams are separate, in-home asthma care programs often braid them together to pay for more services than any one stream can support on its own, and then carefully track the expenditures to report back to funders on how their money was spent. The illustration here represents ways that funding for home-based asthma care services can be combined to cover critical in-home asthma care needs. In addition to combining funding sources, also consider emerging social impact financing and partnering with state or county health, housing or environmental programs to integrate in-home asthma care in their operations.

In 2015, the Commonwealth Fund published several features to examine how, after five years, the Affordable Care Act (ACA) is meeting its aim of achieving quality, affordable health care for all Americans. A multi-media piece looks at various ACA initiatives related to reimbursement system reform to improve care quality and contain costs. Topics covered include Accountable Care Organizations (ACOs), Paying for Value, and Strengthening Primary Care. The stories and payment innovations described may offer opportunities for in-home asthma care.

Webinar: Medicaid 101: What You Need to KnowThe Alliance for Health Reform and the Kaiser Family Foundation, 2013.
This webinar briefing presents the basics of Medicaid and its role in the health care system. Speakers address questions on how the program is administered, how much it costs and how it is financed, as well as how the Affordable Care Act affects the program and what states are doing to transform Medicaid to meet current and future needs of its beneficiaries.

Can We Reduce Childhood Asthma and Lower Costs, Too?The Brookings Institution, 2014.
In this brief web article, the challenge and opportunity of addressing asthma is presented succinctly. The medical system is set up to treat illness, not necessarily to improve health. Health payers, such as Medicaid and private insurance, are used to paying for traditional medical services—often very expensive ones, such as ED treatment or hospitals stays— but not for less expensive non-medical services, such as parent education, home inspections, and cleaning supplies.

Webinar: Practical Strategies for Integrating Clinical and Community Asthma Innovation with Sustainable PaymentWebinar, May 4, 2015.
This webinar focused on a successful community intervention deployed by the St. Louis chapter of the AAFA. Speakers discussed payment and policy options currently being tested by the Center for Medicaid and Children's Health Insurance Program (CHIP) Services and other agencies, assessed challenges and opportunities for innovation, and provided practical strategies and next steps for integrating sustainable payment and system transformation.